Bronchopleural fistula after pneumonectomy.

BACKGROUND: Bronchopleural fistula (BPF) is an infrequent but life-threatening complication after lung resection. The incidence of BPF reported in the literature varies between 0 and 15%. AIM: To evaluate the incidence of BPF after pneumonectomy for primary lung cancer in a single practice using a single technique. METHODS: Hospital records of patients who underwent pneumonectomy from 1 January 1988 to 1 October 1998 were reviewed retrospectively. The bronchial stump was closed using a uniform hand suture technique. There was a total of 157 patients, including 118 males and 39 females with a mean age of 64 years (range 37-78). Sixty-two patients (39.5%) had a right pneumonectomy. RESULTS: Three patients developed BPF (1.9%). All occurred within seven days of the operation. Two of the three patients died. Ventilation for more than 24 hours was found to be the only significant risk factor for the development of BPF (p < 0.001). CONCLUSIONS: Hand suture closure of bronchial stump after pneumonectomy is a safe, reproducible and inexpensive technique, and a low incidence of BPF can be achieved.

Calcification of homograft valves in the pulmonary circulation -- is it device or donation related?

OBJECTIVE: Homograft valved conduits are used in the reconstruction of right ventricular outflow tract (RVOT), and calcification is a recognised phenomenon in these devices. The purpose of this study was to assess the effect of type (pulmonary and aortic) and mode of harvest of these cryopreserved homografts (cadaveric and beating heart) on the incidence of calcification of these conduits when used in the pulmonary circulation. METHODS: A retrospective study was carried out on 60 patients with congenital heart defects who underwent reconstruction of RVOT using cryopreserved homograft valved conduits. The homografts were harvested from two different groups of donors; beating heart donors and cadaveric donors. The period of study was from 1st January 1990 to 31st December 2000. There were 34 males and 26 females, and the median age was 75 months. The 30-day mortality was 10 (16.7%). The 50 survivors were followed-up 3-108 months (median 36 months). Twenty-four had aortic homografts and 26 pulmonary homografts. Twenty-four devices were from cadaveric donors and 26 from beating heart donors. RESULTS: There were 10 (20%) calcified devices, all aortic in origin. In a logistic regression analysis, aortic homografts were significant risk factor for calcification (P=0.0006). However, source of harvest was not significantly related to the incidence of calcification (P=0.6). CONCLUSION: Cryopreserved pulmonary homografts placed in the right side of the heart are less likely to undergo calcification. Homografts harvested from beating heart donors do not appear to reduce the incidence of calcification.